Future Imperfect: the Long-Term Outcome of Depression

Abstract

During 1976, 80 patients with a primary depressive illness were selected from a consecutive series of referrals to the Royal Edinburgh Hospital for a short-term follow-up study. This paper concerns the 12-year longitudinal assessment of the survivors. During the follow-up, mortality risk for the sample was almost doubled. Of the series, 35% had experienced a recurrence within 2 years of the initial interview, and just over 60% within the entire study time of 12 years. The risk of recurrence was enhanced for those aged over 45 years at index, for those with a history of depressive disorder and for those who had not engaged in parasuicidal behaviour during the index episode. The observed effect of previous episodes was largely accounted for by age. The chance of recurrence was not affected by whether the treatment of the index episode included ECT, or by whether diagnosis was 'endogenous' or 'neurotic'. Application of the Lee-Murray outcome criteria showed that about one-third of the Edinburgh series experienced a very poor outcome. Results are presented concerning the prediction of long-term outcome as represented by the Depression Outcome Scale (DOS), a measure specially constructed for this study.

Better outcomes for depressive disorders?

“…Kennedy et al rightly point out that their study provides little if any evidence that modern treatments are impacting on the frequency of recurrence of depressive disorders. Their survival curves of recurrence differ very little from those in the Edinburgh (Surtees & Barkley, 1994) and NIMH (Mueller et al 1999) series that had been ascertained 15 and 10 years previously.…”

“…Kennedy et al (2003) identify four studies published in the past 15 years that embody many of these advances and allow for exploration of possible temporal trends. These include the London, Sydney and NIMH investigations outlined above, and a report from Edinburgh (Surtees & Barkley, 1994), which followed a predominantly in-patient cohort of depressed patients for 12 years.…”

Generalized Anxiety Disorder, Major Depressive Disorder, and Their Comorbidity as Predictors of All-Cause and Cardiovascular Mortality: The Vietnam Experience Study

“…(12,13). Although much of this excess is attributable to non-medical causes of death such as injury and suicide, it is becoming clear that MDD also increases the risk of death from common chronic diseases such as cardiovascular disease (CVD) (14).…”

Psychoanalytic and Psychodynamic Therapies for Depression: The Evidence Base

“…The natural course of depression is often prolonged, relapsing or recurrent (Surtees & Barkley, 1994). Although patients are significantly helped by any well informed and responsive professional intervention, including really good clinical management, the resistant core of any significant psychopathology is a fact of life.…”

“…As these figures suggest, depression can be a circumscribed, selflimiting condition for some people, but a significant proportion will suffer a pattern of remission and relapse (Surtees & Barkley, 1994), and will show a tendency for a deteriorating outlook as time goes by (Paykel, 1994) (Box 1). Yet, the majority of RCTs of psychological therapy and pharmacotherapy involve shortterm treatments of acutephase depression, with nonexistent or brief followups.…”